Request for use of Simulation Space

Does the course meet any of the following criteria? (Choose all that apply)

Hospital/Departmental Sponsorship

Patient Safety Risk Mitigation

Emergency Corrective Action/Reported Adverse Event

Essential Workforce Training/Testing

Expected Impact of Clinical Practice

Expected Patient Care Impact

JEDI Component

Revenue Generation

Other

Requested Location (choose all that apply)

Requested simulation center support (choose all that apply)

The Carl J. Shapiro Institute for Education and Research